Department of Trauma and Orthopaedics, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, United Kingdom.
Spine J. 2011 Mar;11(3):e1-4. doi: 10.1016/j.spinee.2011.01.030.
Vertebral artery damage after cervical fracture and especially cervical dislocations is a recognized phenomenon. The incidence of significant intracranial neurology after unilateral vertebral damage is extremely rare, and to our knowledge, no such injury has been sustained while playing sport.
To describe a rare vascular complication of a bifacet C5-C6 dislocation.
Case report and clinical discussion.
We present a 28-year old white man who was a professional rugby player. He sustained a hyperflexion injury while playing scrum half in a recent league match, which resulted in a C5-C6 dislocation, diagnosed clinically and with a plain radiograph. The patient on admission had complete neurologic loss below C6.
The patient underwent immediate computed tomography and magnetic resonance imaging (MRI) scans that revealed a 50% displacement of C5 on C6 with a complete unifacet dislocation and the other facet partially dislocated. The MRI revealed signal changes in the cord at the C5-C6 level and an intimal tear in the left vertebral artery. The decision was taken to reduce the dislocation when medically stable. A few hours after injury, after an episode of vomiting, the patient sustained a respiratory arrest owing to the embolization of a clot from the left vertebral artery into the basilar artery. Despite rapid embolectomy and subsequent permanent left vertebral artery occlusion, the patient sustained multiple infarcts in the cerebellar, thalamic, occipital, and pontine regions of the brain that eventually proved fatal.
This case shows a rare complication of unilateral vertebral artery occlusion. Despite early identification of a basilar infarct and a successful embolectomy, intracranial infarction occurred. Although there is no guideline for the treatment of vertebral artery damage, early reduction and anticoagulation may reduce the risk of cerebral infarction.
颈椎骨折，尤其是颈椎脱位后椎动脉损伤是一种公认的现象。单侧椎动脉损伤后出现显著的颅内神经病变的发生率极低，据我们所知，在运动中从未发生过此类损伤。
描述一种罕见的颈椎双关节 C5-C6 脱位的血管并发症。
病例报告和临床讨论。
我们介绍了一位 28 岁的白人男性，他是一名职业橄榄球运动员。他在最近的一场联赛中担任 scrum 半卫时遭受了过度伸展损伤，导致 C5-C6 脱位，通过临床和普通 X 光片诊断。入院时，患者 C6 以下完全失去神经功能。
患者立即进行了计算机断层扫描和磁共振成像（MRI）扫描，显示 C5 在 C6 上有 50%的移位，单侧全关节脱位，另一侧关节部分脱位。MRI 显示 C5-C6 水平脊髓信号改变，左侧椎动脉内膜撕裂。决定在患者病情稳定时进行脱位复位。受伤数小时后，在一次呕吐发作后，患者因左椎动脉内的血栓栓塞到基底动脉而发生呼吸骤停。尽管迅速进行了血栓切除术，随后左椎动脉永久闭塞，但患者的小脑、丘脑、枕叶和脑桥区域仍发生了多处梗死，最终导致患者死亡。
本病例显示了单侧椎动脉闭塞的罕见并发症。尽管早期发现基底动脉梗死并成功进行了血栓切除术，但仍发生了颅内梗死。虽然没有椎动脉损伤的治疗指南，但早期复位和抗凝治疗可能会降低脑梗死的风险。
